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Low Back Pain

Overview

It is a musculoskeletal disorder which affects 80% of people. Important structures in the lower area of the back includes lumbar spine and their intervertrebral discs, spinal cords and nerves, ligaments, muscles of lower back, internal organs of pelvis and skin of the lower area. On each side, there is sacrum, a bone which meets the illiac part of the pubic bone and forms the sacro iliac joints of the buttocks.The discs between the vertebrae acts as a cushions or shock absorbers and minimize the stress over there.
Ligaments are the strong fibrous tissue that joins bones. Ligaments attach of the vertebrae to each other and surround each of the discs. The nerves emerges from the spinal cord can be compressed. The aorta and blood vessels carry blood from the lower extremities to the heart and from the heart.
Many muscles in the back are responsible for the movements of waist and the legs. The low back helps in the movement and protection of various organs like uterus, prostate,etc and various other important structures like nerves arising from the spinal cord.


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Causes

The important causes include the skeletal degeneration or injury in the ligaments and muscles.They are usually non specific.
Causes include:

    * Degeneration of the disc
    * Slipped disc
    * Fractures in the bones of pelvis
    * Some immunity related diseases like ankylosis spondylitis
    * Rheumatoid arthritis
    * Some neoplastic tumours like bone tumours.
    * Osteoporotic fractures
    * Sometimes there is refered pain in the from the pelvic organs..


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Signs & Symptoms

    * A low back pain can be a symptom for a disease but there can be radiation of this pain to the front, side or back of the leg.

    * If there is compression of the lower 1st sacral nerve then patient will unable to plantar the flex foot and if there is compression of the 5th lumber nerve then there is inability to raise the big toe upward.

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Prevention

    * As there are many muscles in the back which on strenuous exercises can create tension in the nerves and hence these should be avoided.
    * low impact activities such as swimming, running, bicycling can increase the overall fitness without having too much strain on the back.
    * There are some specific exercises like abdominal crunches can decrease low back pain and they help to strengthen the abdominal muscles also.
    * Belts are available which supports the back called lumbar support belts.
    * while sitting in the car some comfort to the back is given by adjusting the seats or with the pillows. Chairs used for sitting must be of proper height to fully support the back.
    * Bed must not be too hard or soft to sleep.
    * Avoid lifting heavy objects. A technique should be attempted to lift heavy objects in which there is straight back, head up and object is being lifted by folding knees and don't stoop to lift it up.


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Treatments
Pain killers and Muscle Relaxants Modern Medicine

90% of the back pain will go by itself and it needs only rest of two days with decreased activity are enough to cure back pain.
Some pain killers like acetaminophen are useful in treating the back pain.
NSAIDs are used for the treatment of the back pain like ketoprofen, naproxen
Cox-2 inhibitors like celecoxib are more selective members of NSAIDs which are used to relieve pain as they can be given in patients who are suffering from ulcers.

Muscle relaxants are used to relieve the spasm of the muscles.
Opioid analgesics are used for the treatment of the acute back pain but it has many side effects like dependence,nausea,constipation.

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